Analysis: GPs gearing up for ‘Ofsted-style’ ratings

GPs face even greater scrutiny from Big Brother this year, as the CQC prepares to slap one of four ‘Ofsted-style’ ratings on practices.

New chief inspector of general practice Professor Steve Field last month outlined his revamp of inspections, which will come into force this year. He promised it would root out bad care and be understandable for patients.

Practices will begin to be inspected from April using the new approach, which will include greater use of specialist inspectors, questions on how compassionate the care provided is and Ofsted-style ratings, which will begin to be published from October.

The release of the results of the first 1,000 practice inspections, at the same time as Professor Field set out his plans, prompted an immediate furore among GPs. Despite only 2% of practices being identified as having serious failings, national newspapers and BBC outlets focused on the third of practices failing one standard and the finding of supposedly ‘maggot-infested’ surgeries.

GP leaders argued that the sample of practices inspected did not represent a true picture of the profession, pointing out that the majority of the first wave of inspections was of practices where concerns had already been raised. The CQC said later that 63.5% of the first 1,000 inspections were at practices with pre-existing concerns – but said that even among randomly selected practices with no such concerns, 29.2% were found to fail at least one standard.

The credibility of the inspections regime was further tested as initial claims about practices singled out by the CQC for criticism appeared to unravel. One practice reported to have had maggots in a treatment room said in a statement that treatment rooms and consulting areas had not been affected and insisted it had taken immediate action to deal with a small number of insect larvae found in a hallway.

A Pulse survey, conducted immediately after the announcement, showed the debacle has left GPs with little faith in the regulator (see box above).

Former RCGP chair Professor Clare Gerada says GPs are being used as ‘scapegoats’. She says: ‘The leaders of the profession have to come to grips with this before we lose GPs. We, including Professor Steve Field, need to start protecting what we value most.’

But Professor Field says he is ‘very clear’ that only a small number of practices were not compliant with the essential standards. He says: ‘The tiny numbers of very poor practices are letting down their patients and also the profession, but we are pleased that there is significant progress being made by most of the practices that have been identified. It is unfortunate, and I guess inevitable, that the press have focused on those small numbers. Our new model next year will look at and celebrate good and outstanding practices and we have already begun to work with GPs to make sure they are at the forefront of our new approach to inspection.’

What the new inspections will look like

Ofsted-style ratings

From October, practices will begin to be rated as ‘outstanding’, ‘good’, ‘requires improvement’ or ‘inadequate’.

Under an agreement that formed part of the 2014 GP contract deal, practices in England will have to display their rating in the waiting room. Ratings will also be published online and in the local media by the CQC, which is even considering sending letters to all patients of practices where it has found inadequate care.

Professor Field says: ‘In Ofsted, they write a letter to junior school pupils and senior school pupils in a language they understand. I think the principle is a great one, so it will be an open letter to patients. If there’s a practice which is really, really inadequate, the question which I’m toying with is how you make sure patients really, really know.

‘It’s not yet clear how non-compliance with any of CQC’s existing the standards will be linked to the four ratings.’

GP-led inspections

Professor Field has previously said that conducting practice inspections without a GP present was ‘flawed’. To address this, there is a commitment that from April teams of inspectors will include GPs, as well as a nurse and sometimes expert patients.

The CQC document states: ‘Our inspections will be led by expert inspectors, with clinical input led by GPs. The teams will include an inspector, a GP, a nurse and/or a practice manager and a GP registrar. Teams may also include an expert by experience – someone who uses a GP practice or has a particular experience of care that we want to look at.’

Professor Field added that the CQC would set up an ‘academy’ and ‘spend a lot of resource’ on training inspectors to be specialists.

He said: ‘We’re going to train the GPs, the patients, the nurses and the inspectors – together and separately – to gain skills.’

New standards

Professor Field also said that, from April, inspectors will ask for the first time how caring practices are, alongside questions on whether they are safe, effective, responsive and well-led. This will include checking patients are treated with ‘compassion, dignity and respect’. Other new standards will include whether a practice ‘assesses and responds to the needs of the local population’, including access to appointments.

Also to be checked is the way practices respond to feedback, for example through having an effective patient participation group, and how medical records are stored and shared with patients and other services.

Targeting inspections

Inspectors will visit every CCG once every six months, inspecting a quarter of practices, with the CQC hoping to inspect and rate every surgery in England by April 2016. The regulator will then consider how to link inspection frequency with practices’ overall rating.

The new regime will also look at particular services or care pathways, beginning with a comprehensive investigation of GP out-of-hours services, which the document says ‘face particular challenges in providing safe, compassionate care’.